Disparities in developmental-behavioral diagnoses in Hispanic immigrant children: role of parent concern and screening

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PROJECT SUMMARY Developmental-behavioral disabilities are present in nearly 1 in 5 children in the United States and are among the most common concerns parents discuss at primary care visits. Autism Spectrum Disorder (ASD) is one of these conditions, which is characterized by differences in social and sensory processing. While ASD occurs in approximately 1 in 53 children, racial-ethnic groups are diagnosed at different rates. White children have the highest prevalence (2.65%), and Hispanic children are least likely to be diagnosed (1.94%). Moreover, 0.5% of Spanish-speaking children and 0.3% of children with two foreign-born parents have a documented diagnosis. This disparity is similar for other conditions and has a profound impact in access to treatment. Screening in primary care pediatrics is one mechanism for early identification of child risk behaviors; however, this process does not facilitate diagnosis as expected for Hispanic children. This is likely a function of the interplay between parental report of behaviors, validity of screening instruments in this population and provider diagnostic practices. While disparities for Hispanic immigrants and provider’s views are well documented, the mechanisms underpinning differences in diagnosis are not well understood. Additionally, parental perspectives on child’s behavior and diagnosis are insufficiently represented. Rich data on socioecological factors in the context of immigration and child health outcomes are not readily available and relationships are subsequently underexplored. Profound challenges related to resettlement in the United States contribute to risk for developmental-behavioral disorders. Apart from this direct relationship, these immigration-related factors influence how parent’s behavioral concerns develop and are represented on clinical screening instruments. For example, discrimination can increase risk for behavioral disorders in children while simultaneously impacting parent’s perception of these behaviors. This will subsequently affect how well screening instruments capture parent concerns. This study will quantitatively assess how these relationships contribute to diagnostic disparities. The study uses an adaptation of the Trajectory Model for Immigrant/Refugee Health to model relationships between socioecological factors, parent concern for behavior, screening results and clinical diagnosis. This conceptual orientation emphasizes structural contributions to inequalities while providing evidence to support improvements in clinical care for this population. This secondary analysis uses a community sample collected by PolicyLab Research Center at The Children’s Hospital of Philadelphia. Aim 1 will determine the relationship between socioecological clusters and parent reported child concerns. Aim 2 will assess concordance between parental concern and clinical screening results. Aim 3 will test the model proposing parental concern and screening as mediators of socioecological predictors of clinical diagnosis. Analytical strategies include cluster analysis, regression, and structural equation modeling. This study will provide foundational evidence to reduce diagnostic disparities for Hispanic immigrant children.